How Did I End Up in Jail?

Jeffrey E. Keller, MD, describes his journey to correctional medicine

So, let's get the big question out of the way first: how on earth did I, a respectable physician, wind up practicing medicine in a freaking jail, of all places? Well, the answer is that it was a fortunate accident.

Nobody aspires in medical school to practice medicine in a prison or jail. Neither did I. Like most physicians practicing now in jails and prisons (collectively termed "correctional medicine"), I ended up here quite by accident.

I am an emergency physician by training. I had been happily working at a busy emergency department for about 10 years when my local county commissioners approached me to ask if I would be willing to take over medical services at the small local jail. My initial response was: "Hell no! What're ya, nuts? Who'd want to work in a jail?" Many of you probably would have said the same thing! Fortunately for me, the commissioners gave me a second chance 6 months later. I was still leery, but I told them I would do it for 1 year, and 1 year only.

Two things happened during that year, though. First, I discovered that I liked working at the jail (and who would have thought that). In many ways, it was like working in an ER. In fact, many of the "frequent flyers" from the ER also were regular attendees at the jail. I'd see someone in the jail clinic I had seen 2 days earlier in the ER. Or I'd see someone in the ER and ask, "So when did you get out of jail?"

In addition, though, I saw a lot of needy people in the jail who did not routinely come to the ER. For many people, jail is the first time that they have had easy access to medical care. I saw medical issues that had been neglected for years. A typical exchange would be: "What do you think of this growth on my hand?" "Well, that's cancer." I'm not sure what I had naively expected, but what I found was a lot of untreated interesting medical pathology. I've diagnosed bacterial endocarditis -- several times (lots of IV heroin users go to jail). I've diagnosed syphilis. Within a couple of months, I had treated more people for alcohol withdrawal than I had in my entire ER career. I felt good about what I was doing. Weird!

Second, my phone kept ringing. "We're the jail just up the road. We need help, too!" "We're the jail down the road. We need a doc." It turns out that there are a lot of jails. But there are not a lot of physicians raising their hand to volunteer for jail medical duty. I was practically the only guy in my home state of Idaho. After a few years, I had accumulated so many small jails that I retired from the ER to do jail medicine full time. And Idaho is not the only place with a need for correctional medicine practitioners.

There are well over 2.2 million incarcerated people in the United States, and they all need healthcare. In fact, incarcerated people are the only residents of the U.S. with a constitutional guarantee of healthcare. The Supreme Court ruled in 1976 that to deny necessary medical care to an incarcerated inmate constituted cruel and unusual punishment. Because of this ruling, every correctional facility, even a tiny county jail with only 10 beds, has to have some program in place to provide medical, dental, and mental healthcare to its inmates. No wonder my jails were so eager to find a willing medical practitioner!

One other thing happened, though, when I began to practice jail medicine full time -- I became almost invisible to the rest of the medical community. When I was in the ER, I bumped shoulders with the other medical staff all of the time. Now, though, the only time I see my colleagues is when I run into them at the grocery store. And when I tell them that I left the ER to work in jails full time, I often get a quizzically raised eyebrow. I can see them thinking "What're ya, nuts? Who'd want to work in a jail?" Their next question, though, is typically "What is it like?"

The thing is: I like working in jails. I was never unhappy as an ER physician. But I get more overall satisfaction out of my work in jails and prisons. This column will be my forum to tell you why.

Jeffrey E. Keller, MD, FACEP, is a board-certified emergency physician with 25 years of experience before moving full time into his "true calling" of correctional medicine. He now works exclusively in jails and prisons, and blogs about correctional medicine at JailMedicine.com.

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